The
following is an exclusive excerpt
from the "Sexually Transmitted Diseases"
chapter of Our
Bodies, Ourselves for the New Century.
For complete information and resources,
we recommend that you consult the
chapter and the book in its entirety.

WHAT
ARE STDs?

``STD'' is a term applied to more
than two dozen diseases that are
transmitted primarily through anal,
oral, or vaginal sex. Their effects
are not limited to the reproductive
organs, and they do not always have
to involve sexual activity, but
most often they do. In most cases,
the organisms that cause STDs enter
the body through the mucous membranes:
the warm, moist surfaces of the
vagina, urethra, anus, and mouth.
However, in some instances, exposure
to sores or other types of skin-to-skin
contact may be sufficient to transmit
infection (see description of each
disease). In addition, any cuts
or lesions that allow germs to get
into the bloodstream may increase
the risk of transmission, particularly
for blood-borne infections such
as HIV and hepatitis B.

Most STDs that are caused by bacteria,
protozoa, and other small organisms
can usually be cured with antibiotics
or topical creams and lotions. Among
the most common STDs are two bacterial
infections known since ancient times:
syphilis and gonorrhea (the ``clap'').
A third, chlamydia, is becoming
alarmingly widespread today. All
three may be cured with antibiotics,
but they can cause serious complications
if left untreated.

Viral infections, however, while
treatable, are not curable. These
include herpes; human papillomavirus
(HPV), which causes genital warts;
and human immunodeficiency virus
(HIV), which produces AIDS. Treatment
may help relieve the symptoms and/or
slow the progression of the disease.

Hepatitis is the only STD for which
a vaccine exists. Some other common
STDs include trichomoniasis, which
is caused by protozoa and is treated
by a simple oral antibiotic, and
scabies and crabs, which are tiny
organisms that infest the skin or
pubic hair and can be treated by
the application of topical creams
and lotions. Bacterial vaginosis
may or may not be sexually transmitted,
because changes in vaginal flora
(the organisms that naturally live
in a healthy vagina) may occur without
sexual contact. There are over 24
STDs, more than we will be able
to cover in this chapter. For additional
descriptions of STDs, read chapters
15, HIV, AIDS, and Women, and 24,
Selected Medical Practices, Problems,
and Procedures, or the STD Handbook
(Montreal Health Press). See the
Resource section for a complete
listing.

HOW LIKELY AM I TO GET AN STD?

The most likely way to get an STD
is to engage in unprotected vaginal,
anal, or oral sex, although the
diseases described in this chapter
can also be transmitted through
other intimate sexual and skin-to-skin
contact and through donor insemination.

In general, any physical activity
that allows blood or other infected
body fluid or tissue to come in
contact with the mucous membrane,
or to enter the body through cuts
or lesions, could transmit an STD.
Oral sex, penetration with fingers,
and sharing infected and unsterilized
sex toys, as well as touching open
sores and then other parts of the
body, may all be potential ways
to transmit diseases. If any of
your sexual partners (or their partners)
has an STD, you are likely to become
infected unless you practice prevention
consistently. Although it is rare
for STDs to be transmitted on inanimate
objects, contagion is possible when
fresh body fluids are on the object
(such as a shared sex toy). Toilet
seats or towels are possible but
unlikely routes of transmission.

Statistically, if you are young
(between 15 and 24), are sexually
active with more than one partner,
and live in an urban setting, where
the number of people with STDs is
greater and other risk factors are
multiplied, you are at highest risk.
Unprotected sex with a new partner,
or with anyone whose sexual history
you do not know, may put you at
risk. For many women, poverty may
contribute to a higher risk of STD.
Not having enough money can mean
lack of access to prevention and
treatment, engaging in commercial
sex work, economic dependence on
a partner who may be exposing you
to infection, or just being preoccupied
with day-to-day survival, so that
STD prevention may not be your highest
priority.

Some biological factors may also
affect risk for certain groups of
women. In young girls, the cervix
is not yet fully developed and is
more vulnerable to infection. Older
women are more likely to get small
abrasions in the vagina during sexual
activity as a result of thinning
of the membrane and, possibly, dryness.
Women who already have an infection,
particularly one with genital lesions,
are more likely to get or transmit
another STD, including HIV.

If you are a woman who has sex exclusively
with other women, your chances of
getting an STD are significantly
lower. However, since many women
who consider themselves lesbian
may also, currently or in the past,
have been involved with men, it
is more difficult to determine the
risk of transmission exclusively
from woman to woman. More research
is needed in this area.

BRIEF
SUMMARY OF PRECAUTIONS

1.
STDs are very common. If you are
sexually active in anything but
a totally monogamous relationship
with someone who is having sex only
with you and does not have an STD,
you have a high risk of getting
an STD. If your partner is not monogamous,
you may be exposed to STDs, including
HIV, from your partner's partners.

2. The best way to deal with STD
is to avoid getting it in the first
place. Practice prevention wherever
possible. See the box on p. 344
for more information.

3. If you think there is the slightest
possibility that you or your partners
have an STD, get medical attention
as soon as you can. Remember, you
might not have any symptoms. In
the meantime, try to find out whether
the person you had sex with has
been exposed to an STD.

4. Don't have sex until you and
all your current partners (and their
partners) have been tested, treated,
and cured (check with your health
care provider).

5. If you do have an STD, inform
all your recent partners personally.
Even an anonymous letter will do.
The partner notification services
available at local Department of
Health offices will inform people
anonymously, without revealing your
identity.

6. Before accepting treatment, make
sure you understand what you are
taking and for how long, the side
effects, and any followup tests
or treatment required. Don't be
embarrassed about asking questions.
It's your life, not theirs.

7. Remember, even if you are cured
you can get the same STD again.
Also, having one STD doesn't protect
you from getting others. Viral STDs--such
as herpes, HPV (genital warts),
and HIV--cannot be cured. Specific
treatment and management strategies
are covered later in this chapter
and in chapters 15, HIV, AIDS, and
Women, and 24, Selected Medical
Practices, Problems, and Procedures.

PREVENTING SEXUALLY TRANSMITTED
DISEASES

Using any of the prevention methods
described below should reduce your
chances of catching an STD. Consider
using more than one method since
no method, including condoms, is
100% effective.

1. Latex condoms (rubbers) used
during vaginal, oral, and anal intercourse
are the best-known preventive method.
The man or you must put the condom
on his penis before it touches your
vulva, mouth, or anus. If you or
your partner experiences irritation
or other adverse reactions to latex
condoms, try another brand, a polyurethane
condom, or condoms without spermicide.
Condoms without nonoxynol-9 are
available for oral sex, in flavors
that may make them more pleasant
to use. Latex condoms have been
more widely tested and found effective
for disease prevention, but polyurethane
condoms also provide protection.
Never use an oil-based lubricant--such
as Vaseline--with latex, as it will
break down the rubber and destroy
its protection. (See chapters 13,
Birth Control, and 15, HIV, AIDS,
and Women.)

2. Use the new female condom (Realityrm,
Femidomrm, Femyrm). This could be
useful if your male partner(s) can't
or won't use condoms. Small amounts
of any lubricant, including oil-based
ones, may be used inside the pouch
or on the penis. Using a spermicide
containing nonoxynol-9 with the
female condom may irritate the vaginal
surface. (See chapter 13, Birth
Control, for more information on
the female condom.)

3. Use vaginal spermicides (contraceptive
foams, films, creams and jellies).*
You can purchase them in a drugstore
without a prescription and use them
with or without a diaphragm or condom.
Using a barrier contraIceptive--condom
or diaphragm--with spermicide may
increase your protection. When using
a condom, put an applicatorful of
spermicide inside the vagina before
sexual intercourse.

Using
nonoxynol-9 can irritate the vaginal
mucosa. Whether this increases the
risk of HIV transmission is still
uncertain. The question is controversial
because much of the research indicating
increased risk was based on very
frequent use among sex workers.

4. A diaphragm (with spermicide)
gives better protection against
STDs that affect the cervix, 5.
such as gonorrhea and chlamydial
infection. Other cervical barrier
contraceptives, such as caps and
the sponge, have not proved to be
as effective for STD prevention.
Cervical barriers do not protect
you from infection in other parts
of the body, such as the vulva,
vagina, or rectum, by organisms
such as herpes, warts, or syphilis.

5. Washing the genitals before and
right after sex may not help much.
Douching, in most cases, does not
prevent STD, as it washes away the
normal vaginal secretions that help
our bodies fight off infection and
may even push infections higher
up in your reproductive system.
Men should wash their testicles
and penis, particularly after anal
sex and before going on to vaginal
or oral sex.

6. Barrier methods can be used for
mouth-to-vagina or mouth-to-anus
contact. Dental dams (squares of
latex used by dentists) can be used
as a barrier for oral sex. Some
people now place household plastic
wrap over the area before contact,
then discard it after one-time use.
If nothing else is available, you
can cut up a latex glove and use
that as a barrier.

Remember:
Barriers don't protect you from
an infection on parts of the body
that they do not cover.

7. Avoid sharing sex toys. Body
secretions on sex toys may transmit
STDs. Some people soak sex toys
in hydrogen peroxide for 15 minutes.
Also, be very careful in any sexual
activities that involve blood, including
bondage and discipline. Direct contact
with the blood--including menstrual
blood--of an infected person can
transmit HIV or hepatitis.

8. Talk to your lover about STD
before having sex. Ask if she or
he has been exposed to an STD. This
is especially important if you are
pregnant! Look carefully at your
body and your lover's, checking
for a bad smell, an unusual discharge,
sores, bumps, itching, or redness.
If you think you or your partner
may have an infection, don't touch
the sores or have sex. Also, remember
that a person may be infected with
an STD, such as herpes or HIV, and
look completely healthy.

It's
one thing to talk about ``being
responsible about STD'' and a much
harder thing to do it at the moment.
It's just plain hard to say to someone
I am feeling very erotic with, ``Oh,
yes, before we go any further, can
we have a conversation about STD?''
It is hard to imagine murmuring
into someone's ear at a time of
passion, ``Would you mind slipping
on this condom just in case one
of us has an STD?'' Yet, it seems
awkward to bring it up any sooner
if it's not clear between us that
we want to make love.

For some ideas on how to talk about
sex more comfortably with a lover,
see chapter 11, Sexuality.

9. We do not recommend morning-after
antibiotics for STDs. Taken
just before or within nine hours
after exposure to an infected person,
these antibiotic pills contain enough
drug to prevent these diseases,
but not enough to cure an established
infection. Taking antibiotics frequently
or in less than the optimal dosage
may encourage the development of
resistant strains of bacteria.

*Many creams, films, foams, and
jellies have been shown in the laboratory
to kill organisms that cause gonorrhea,
syphilis, trichomoniasis, candidiasis,
chlamydial infection, HIV infection,
and herpes. In actual use, they
have been shown to be effective
only against chlamydial infection
and gonorrhea. Test your sensitivity
to these products on your body before
using them during sex. Try latex
separately from nonoxynol-9, and
experiment with different brands
of condom or spermicide. These products
have not been tested for use in
anal sex.